Advanced squamous cell carcinoma of the head and neck or esophagus have very poor five-year survivals despite aggressive local treatment with surgery, radiotherapy or both. Many such patients die of metastatic disease. Therefore, a pilot trial of aggressive combination chemotherapy is warranted to determine if an improved response rate or survival can be obtained. Bleomycin, cis-platinum II with hydration, and high-dose methotrexate with citrovorum rescue are agents with activity in these tumors. The current study utilizes a combination of these 3 agents to determine toxicity, response rate and duration. Twenty-three patients with stage III and IV were treated with a single course of combination chemotherapy. Fourteen of 23 patients showed a greater than 50% response. Nine of these patients underwent extirpative surgery and tolerated it well. Toxicities have been managable by careful hydration and careful folinic acid reversal. There were two drug-related deaths.